164 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP
saying, “It’s my wife’s fault that I drink and get into
fights, because she nags me all the time.” This client
is not accepting responsibility for his drinking and
fighting. Another example of poor insight would be the
client who expects all problems to be solved with little
or no personal effort, saying, “The problem is my med-
ication. As soon as the doctor gets the medication right,
I’ll be just fine.”
Self-Concept
Self-conceptis the way one views oneself in terms of
personal worth and dignity. To assess a client’s self-
concept, the nurse can ask the client to describe him-
self or herself and what characteristics he or she likes
and what he or she would change. The client’s descrip-
tion of self in terms of physical characteristics gives
the nurse information about the client’s body image,
which is also part of self-concept.
Also included in an assessment of self-concept
are the emotions that the client frequently experi-
ences, such as sadness or anger, and whether or not
the client is comfortable with those emotions. The
nurse also must assess the client’s coping strategies.
He or she can do so by asking, “What do you do when
you have a problem? How do you solve it? What usu-
ally works to deal with anger or disappointment?”
Roles and Relationships
People function in their community through various
roles such as mother, wife, son, daughter, teacher, sec-
retary, or volunteer. The nurse assesses the roles the
client occupies, client satisfaction with those roles,
and if the client believes he or she is fulfilling the roles
adequately (Hanna & Roy, 2001). The number and
type of roles may vary, but they usually include fam-
ily, occupation, and hobbies or activities. Family roles
include son or daughter, sibling, parent, child, and
spouse or partner. Occupation roles can be related to
a career, school, or both. The ability to fulfill a role or
the lack of a desired role is often central to the client’s
psychosocial functioning. Changes in roles also may be
part of the client’s difficulty.
Relationships with other people are important to
one’s social and emotional health. Relationships vary
in terms of significance, level of intimacy or closeness,
and intensity. The inability to sustain satisfying rela-
tionships can result from mental health problems or
can contribute to the worsening of some problems. The
nurse must assess the relationships in the client’s life,
the client’s satisfaction with those relationships, or
any loss of relationships. Common questions include
the following:- Do you feel close to your family?
- Do you have or want a relationship with a
significant other? - Are your relationships meeting your needs
for companionship or intimacy? - Can you meet your sexual needs
satisfactorily? - Have you been involved in any abusive
relationships?
If the client’s family relationships seem to be a
significant source of stress or if the client is closely
involved with his or her family, a more in-depth as-
sessment of this area may be useful. Box 8-3 is the
McMaster Family Assessment Device, an example of
such an in-depth family assessment.
Physiologic and Self-Care
Considerations
When doing a psychosocial assessment, the nurse
must include physiologic functioning. Although a full
physical health assessment may not be indicated,
emotional problems often affect some areas of physi-
ologic function. Emotional problems can greatly affect
eating and sleeping patterns: under stress, people
may eat excessively or not at all, and may sleep up
to 20 hours a day or be unable to sleep more than 2 or
3 hours a night. Clients with bipolar disorder may not
Self concept eat or sleep for days. Clients with major depression